03-101463 �` • CONSTRUCTI• PERMIT APPL CATION
CITY OF �i APPLICATION NUMBER:(' 7 - 1 014 (73- co co
Federal Way APPLICATION NUMBER: -
'APPLICATION NUMBER: - -
"'The following is required information-Please print(in ink)or type"
Please note: Electrical, Fire Prevention Systems and Engineering permits may require a separate application. 1
- lit
-
- IIPROPERTY INFORMATION
SITE ADDRESS:gZ/ Pr1�4 tfG /bit SO i ASSESSOR'S TAX/PARCEL #: -
LEGAL DESCRIPTION OF SUBJECT PROPERTY(ATTACH SEPARATE DESCRIPTION IF LENGTHY):
- - ■ PROJECT INFORMATION
TYPE OF PROJECT(This application): o BUILDING o PLUMBING o MECHANICAL DEMOLITION
o ELECTRICAL o ENGINEERING 0 FIRE PREVENTION SYSTEM /
PROJECT DESCRIPTION(Provide detailed description): o fj-G_ /i4± V 0�.. Pays f-rfr r 1 (I/tad-5
64/41-4 &•,...I1Zr`7.7.) PC.e.Af(9 ale— CcrA.12 --1---
PROJECT NAME:
■ PEOPLE INFORMATION
PROPERTY OWNER: NAME: /I / i DAYTIME PHONE
itS5140 l e,Se (- -u / (?v6) 72s-- 7268'
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP):
S�S/I /filar-f`►:n La -Pit 0.r r y T.^. Jcc S, -er 4. 1 A • q 't i Y
CONTRACTOR: NAME: DAYTIME PHONE:
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): I EVENING PHONE:
II O�` - 3 .54- /J(. /V/ 5c� cg, zoo) 6,a - 2f
CITY OF FEDERAL WAT BUSINESS UCEN E NUMBER: FAX NUMBER:
- - E N
CONTRACTOR'S EXPIRATION DATE:REGISTRATION NUMBER: TIOLa c�
1
(may a card required) L-V Al C. 3 K_ 4. { S l 2$-- t o`-'-
APPLICANT: NAME: D DAYTIME PHONE
), L'd 4--e- I ( )
MAILING ADDRESS(STREET ADDRESS;CITY,STATE,ZIP): / EVENING PHONE:
S 02AAn.-e-- ct (;4j d u- -
RELATIONSHIP TO PROJECT: j FAX NUMBER:
❑ ARCHITECT o TENANT HER( DESCRIBE):&.i Lem, - c-cedcz►- ( -
I
E-MAIL ADDRESS:
CONTACT PERSON FOR THIS PROJECT: o PROPERTY OWNER o APPLICANT o CONTRACTOR
■ DETAILED BUILDING INFORMATION
EXISTING USE: -chi pcot4S EXISTING BUILDING ASSESSED/APPRAISED VALUATION $
PROPOSED USE: PROPOSED VALUATION FOR IMPROVEMENTS: $ 26vo-
SPRINKLERED BUILDING? 0 YES 0140 FIRE SUPPRESSION SYSTEM PROPOSED/REQUIRED:o YES 110
WATER SERVICE PROVIDER: o LAKEHAVEN 0 HIGHLINE ❑ TACOMA 0 PRIVATE(WELL)
SEWER SERVICE PROVIDER: 0 LAKEHAVEN 0 HIGHLINE 0 PRIVATE(SEPTIC)
**NEW RESIDENTIAL CONSTRUCTION Oa* •
NUMBER OF BEDROOMS: ESTIMATED SELLING PRICE: $
■ PROJECT FLOOR AREAS
FLOOR EXISTING SQ.FT. PROPOSED SQ.FT. TOTAL
BASEMENT
FIRST
SECOND
THIRD 1 13 C,00
FOURTH
OTHER FLOORS(DESCRIBE)
DECK
GARAGE
HOW MANY FLOORS?
TOTAL:
■ FIXTURES
Indicate number of each type of fixture
MECHANICAL
AIR HANDLING UNIT(S) EVAPORATIVE COOLER(S) GAS LOG(S) REFRIG.SYSTEM(S)
BBQ(S) FAN(S) HOOD(S) WOODSTOVE(S)
BOILER(S) FIREPLACE INSERT(S) RANGE(S) MISC.( )
COMPRESSOR(S) FURNACE(S)
DUCT(S) GAS PIPE OUTLET(S) HEAT SOURCE: o ELECTRIC o GAS
PLUMBING
BATHTUB(S) LAVATORY(S) URINAL(S) WATER HEATER(S)
DISHWASHER(S) RAIN WATER SYS. VACUUM BREAKER(S) o ELECTRIC ❑ GAS
DRINKING FOUNTAIN(S) SHOWER(S) WASH MACHINE OUTLET
GAS PIPE OUTLET(S) SINK(S) WATER CLOSET(S) MISC.( )
INTERCEPTOR(S) SUMP(S)
■ DISCLAIMER/SIGNATURE BLOCK
I certify under penalty of perjury that the Information furnished by me is true and correct to the best of my knowledge,and
further,that I am authorized by the owner of the above premises to perform the work for which the permit application is made. I
further agree to hold harmless the City of Federal Way as to any daim(induding costs,expenses,and attorneys'fees Incurred in the
investigation and defense of such daim),which may be made by any person,induding the undersigned,and filed against the City of
Federal Way,but only where such daim arises out of the reliance of the city,induding its officers and employees,upon the accuracy
of the information supplied to the dty as a part of this application.
NAME/TITLE
7IG DATE: /S
7 -
o PROPERTY OWNER o APPLICANT ACTOR
FOR OFFICE USE ONLY: 1
D NEW " r d ADDITIUN. D%1LTERATION "o REPAIit _ i�}TENANT IMPROVEMENT Y
'CENSUS CODE '4 ,43.V :_ VV4WP M0. *. LOT .:.,
ZONING DESIGNATION._; t` _ .� .__ BUILDING,SHELL'ONLY?`-'0 YES .❑ NO
COMP PLAN DESIGNATION � -� '� � �:''.ri-�' 11 BASIC PLAN?:c4: -.p YES "=`❑ NO
SECTION--'.: -$TOWNSHIP k; RANGE NEW ADDRESS REQUIRED? ❑'YES ❑ NO
"'PLATTED LOT? 7q YES °; o NII ,` , '`CHANGE OF USE? ` k ❑YES`'-Et NO'
COMMUNITY DEVELOPMENT SERVICES•33530 FIRST WAY SOUTH•PO BOX 9718•FEDERAL WAY,WA 98063-9718•253-661-4000•FAX:253-661-4129
www.cltvoffederalway.com